Awake CT-guided percutaneous stylomastoid foramen puncture and radiofrequency ablation of facial nerve for treatment of hemifacial spasm

Bing Huang MD1, Ming Yao MD1, QiLiang Chen MD, PhD2, Huidan Lin MD3, Xindan Du MD4, Hao Huang MD5, Xian Zhao MD6, Huy Do MD7, and Xiang Qian MD, PhD2
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  • 1 Department of Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang, People’s Republic of China;
  • | 2 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California;
  • | 3 Department of Pain Medicine, The First Hospital of Ninbo, Zhejiang;
  • | 4 Department of Pain Medicine, Hangzhou Red Cross Hospital, Hangzhou;
  • | 5 Department of Pain Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou;
  • | 6 Department of Pain Medicine, Shulan Hospital, Hangzhou, People’s Republic of China; and
  • | 7 Department of Interventional Neuroradiology, Stanford University, Palo Alto, California
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OBJECTIVE

Hemifacial spasm (HFS) is a debilitating neuromuscular disorder with limited treatment options. The current study describes a novel minimally invasive procedure that provided effective and sustained relief for patients with HFS. The authors provide a detailed description of the awake CT-guided percutaneous radiofrequency ablation (RFA) of the facial nerve for treatment of HFS, and they examine its clinical efficacy. This is the first time in the literature that this procedure has been applied and systematically analyzed for HFS.

METHODS

Patients with a history of HFS were recruited between August 2018 and April 2020. Those with a history of cerebellopontine lesions, coagulopathy, ongoing pregnancy, cardiac pacemaker or defibrillator implants, or who declined the procedure were excluded from the study. Fifty-three patients who met the study criteria were included and underwent awake CT-guided RFA. Under minimal sedation, a radiofrequency (RF) needle was used to reach the stylomastoid foramen on the affected side under CT guidance, and the facial nerve was localized using a low-frequency stimulation current. Patients were instructed to engage facial muscles as a proxy for motor monitoring during RFA. Ablation stopped when the patients’ hemifacial contracture resolved. Patients were kept for inpatient monitoring for 24 hours postoperatively and were followed up monthly to monitor resolution of HFS and complications for up to 19 months.

RESULTS

The average duration of the procedure was 32–34 minutes. Postoperatively, 91% of the patients (48/53) had complete resolution of HFS, whereas the remaining individuals had partial resolution. A total of 48 patients reported mild to moderate facial paralysis immediately post-RFA, but most resolved within 1 month. No other significant complication was observed during the study period. By the end of the study period, 5 patients had recurrence of mild HFS symptoms, whereas only 2 patients reported dissatisfaction with the treatment results.

CONCLUSIONS

The authors report for the first time that awake CT-guided RFA of the facial nerve at the stylomastoid foramen is a minimally invasive procedure and can be an effective treatment option for HFS.

ABBREVIATIONS

ASA = American Society of Anesthesiologists; HFS = hemifacial spasm; MVD = microvascular decompression; RF = radiofrequency; RFA = RF ablation.

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Contributor Notes

Correspondence Xiang Qian: Stanford University School of Medicine Pain Management Center, Redwood City, CA. xqian@stanford.edu.

INCLUDE WHEN CITING Published online April 16, 2021; DOI: 10.3171/2020.10.JNS203209.

B.H. and M.Y. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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